MEDICARE: PINE FORREST FUNCTIONAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1154915205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE FORREST FUNCTIONAL MEDICINE

Provider Business Mailing Address
First Line	:	25312 I H 45
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1449
Country	:	US
Telephone Number	:	346-418-9642
Fax Number	:	713-513-5524

Provider Business Practice Location Address
First Line	:	25312 I H 45
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1449
Country	:	US
Telephone Number	:	346-418-9642
Fax Number	:	713-513-5524

Authorized Official
Title or Position	:	OWNER
Name	:	THU ANH HOANG
Credential	:	MD
Telephone Number	:	972-743-5136

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	11/01/2025

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Directions to “PINE FORREST FUNCTIONAL MEDICINE ” Practice Location

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